Internal conflict can hobble a radiology group if it's not addressed, with potential disagreements ranging from intergenerational clashes over flexible scheduling to disputes about workload, according to a speaker at this week's Radiology Business Management Association (RBMA) annual meeting in Orlando, FL.
Will Latham of Latham Consulting Group in Chattanooga, TN, offered a primer on how to address and resolve conflict in radiology groups in a speech on Tuesday to RBMA attendees. He sees the most common types of conflicts occurring in three main areas: alternative work patterns, productivity, and problematic physician behavior.
"One of the overarching issues with these three problem areas is that there's an intergenerational conflict going on in radiology groups," Latham said. "There are now four generations trying to work side-by-side, each with different viewpoints and goals: the traditionalists, the baby boomers, the Generation Xers, and the fourth group, the Nexters. The clashes between these four generations create pressure."
New ways of working
These four generations view work differently, Latham said. All have their strengths, but they clash over issues such as career goals, rewards, work/life balance, job changing, training, and feedback. Younger radiologists may come into practices wanting to split positions or work part time right away; radiology groups need to decide whether to offer these kinds of alternative work programs, and, if so, how to administer them.
"Alternative work programs have historically been for old-timers in the practice, but not anymore," Latham said. "Nexters are coming into the field wanting a balanced lifestyle right now. They don't want to go into full-time positions, necessarily. And offering different ways of working can be complex."
Consider these questions, Latham suggested:
- What's your group's goal in offering an alternative work program?
- What are the requirements to enter it?
- Do its participants continue as voting shareholders in the group?
- How much does participating in an alternative work program cost the group?
- How does participating benefit the group?
- Who gets priority in participating in the alternative work program? (Is it first come, first serve? Is it according to tenure?)
Fortunately or unfortunately, offering flexible work options is becoming increasingly necessary to attract new radiologists, a truth that can be hard for old-timers -- who may be resistant to change -- to accept.
"But if you don't like change, you're going to like irrelevance even less," Latham said.
Process toward productivity
There's no single, fully accepted method for evaluating who is being productive in a group and who isn't, Latham said, partly because there is no one way to define "work."
"Productivity issues can drive radiologists crazy because most groups share the money equally, but there is often a feeling that not everyone is working as hard as everyone else," Latham said. "Unfortunately, there is no one accepted methodology to assess productivity, so some groups just turn a blind eye to it. Most members of groups work hard, but there are always a few who don't and take advantage of the fact that the group won't challenge them."
Groups may use relative value units (RVUs) to assess productivity, but according to Latham, 61% of radiology group members don't know how many RVUs they generate per year.
Does the group track work RVUs? Does it track other markers of "work"? Does it share this information, and, if so, with whom? Does it base any part of its compensation system on it?
Some groups don't collect or share this information with anyone because it's too controversial, Latham said. Other groups designate a committee to review the information and determine whether anyone is out of line. Still others publish the information openly, in the hope that peer pressure and threat of embarrassment will keep all the group's members working within a particular productivity range.
Problem physicians
Most radiology groups have their members performing within a certain range of acceptable behavior. But there are always outliers, and tension can arise as the group tries to decide how to pull the outlaws back in line.
"Many groups just make the range of acceptable behaviors bigger," Latham said. "But eventually, you're going to have to deal with people who are causing problems for the practice."
There are prevention methods and enforcement methods, and both are important, according to Latham. A radiology group should have a well-constructed disciplinary enforcement process -- but prevention is even better. To that end, radiology groups can do several things:
- Conduct their recruiting carefully, taking time to determine if a candidate fits into the group's culture.
- Offer a mentoring structure that instills the group's culture in new recruits.
- Perform ongoing physician evaluation to prevent group members from drifting out of the fold.
Developing a code of conduct in which acceptable and unacceptable behaviors are outlined is key to managing problem physicians, Latham said. Radiology groups should include expectations for the following in their code of conduct:
- Acceptable and unacceptable behaviors
- Rights and responsibilities of each physician
- Interactions between physicians
- Interactions with employees
- Interactions with those outside the group
- Practice management responsibilities
- Support of group decisions, established goals, and policies
"A code of conduct takes the invisible circle of expectations for group behavior and makes it more formal," he said. "It makes it possible for one person to say to another in the group, 'Look, you're not doing what we say we do in this practice.' It's a good vehicle to communicate what the group finds important."
Decisions, decisions
The crux of handling tough radiology group issues often comes down to how the group decides it will make decisions, Latham said, and how group members respond to decisions that are made.
"Most groups have a problem making and sticking with decisions," Latham said. "Physicians think, 'If I didn't vote for it, I don't have to support it.' And their colleagues don't want to tell them what to do."
Consider how the group will make decisions, what is expected of each physician once the decision has been made, and what a physician's options are if he or she doesn't like it.
"What is expected once a decision is made?" he said. "The answer should be: Abide by it. But some physicians self-select out of the group over decisions they don't agree with. If a doctor doesn't want to live by the group's rules, he won't stay in the group."
Although it may seem that the outside forces affecting radiology groups are more pressing, tackling internal issues such as alternative work programs, productivity, and problem physicians is key to a radiology group's health, according to Latham.
"If these issues aren't addressed, the group is going to have an increasingly difficult time recruiting and retaining people," Latham said.
By Kate Madden Yee
AuntMinnie.com staff writer
June 9, 2009
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